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Two Cheers for E-Cigarettes

Imagine a product — a legal but lethal one — that kills 400,000 Americans a year. Public health advocates have been trying for decades to persuade Americans not to use it. The industry has been sued and sued again, but it is still operating profitably. One out of every five Americans is addicted to the product.

Now imagine that an alternative comes to the market, an innovative device that can help people wean themselves from the deadly product. It has the same look and feel as the lethal product; indeed, that’s a large part of its appeal. It, too, is addictive. But the ingredients that kill people are absent.

This, of course, is no imaginary scenario. The lethal product is cigarettes, which use nicotine to addict and combustible tobacco to kill. And the alternative is electronic cigarettes, which deliver nicotine without the tobacco, and emit a vapor that almost instantly evaporates. Yes, users can be hooked on nicotine, which is a stimulant. But people who “vape” are not going to die, at least not from inhaling their cigarette.

You’d think that the public health community would be cheering at the introduction of electronic cigarettes. We all know how hard it is to quit smoking. We also know that nicotine replacement therapies, like the patch, haven’t worked especially well. The electronic cigarette is the first harm-reduction product to gain serious traction among American smokers.

Thomas Farley, New York City’s health commissioner, trotted out most of the rationales against e-cigarettes the other day at a City Council hearing. (The City Council is considering a bill, strongly supported by the Bloomberg administration, that would forbid the use of an e-cigarette anywhere that cigarettes are banned.) E-cigarettes, he said, “are so new we know very little about them.” Thanks to e-cigarettes, smoking is becoming glamorous again, and could become socially acceptable. The number of high school students who have tried electronic cigarettes doubled from 2011 to 2012. He made a particular point of showing how closely e-cigarettes resembled old-fashioned tobacco cigarettes.

The reason to fear this resemblance, say opponents of electronic cigarettes, is that “vaping” could wind up acting as a gateway to smoking. Yet, so far, the evidence suggests just the opposite. Several recent studies have strongly suggested that the majority of e-cigarette users are people who are trying to quit their tobacco habit. The number of people who have done the opposite — gone from e-cigarettes to cigarettes — is minuscule. “What the data is showing is that virtually all the experimentation with e-cigarettes is happening among people who are already smokers,” says Michael Siegel, a professor at the Boston University School of Health.

Siegel is a fierce critic of tobacco companies, but he’s also not afraid to criticize the anti-tobacco advocates when they stretch the truth. When we got to talking about the opposition to e-cigarettes in the public health community, he said, “The antismoking movement is so opposed to the idea of smoking it has transcended the science, and become a moral crusade. I think there is an ideological mind-set in which anything that looks like smoking is bad. That mind-set has trounced the science.”

Another person who considers e-cigarettes promising is David Abrams, the executive director of the Schroeder Institute for Tobacco Research and Policy Studies. “It’s a disruptive technology,” he said, “that might give cigarettes a run for their money.” In his view, the anti-tobacco advocates had spent so many years arguing from “a total abstinence framework,” that they haven’t been able to move from that position. Yet, he noted, the country has long tolerated many similar harm reduction strategies, including needle exchanges and methadone maintenance.

None of this is to say that electronic cigarettes should be free of regulation. But they should be regulated for what they are — a pharmaceutical product that delivers nicotine, not a conduit for tobacco poison. Let them make health claims — which they can’t now do — so long as they are backed up with real science. And, most of all, use e-cigarettes to help make “real” cigarettes obsolete.

At that recent New York City Council meeting, one of the fiercest critics to testify was Kevin O’Flaherty of the Campaign for Tobacco-Free Kids. “If it walks like a duck and it talks like a duck and it sounds like a duck and it looks like a duck, it is a duck,” he said.

Is this what passes for science when you oppose electronic cigarettes?

A version of this op-ed appears in print on December 7, 2013, on page A21 of the New York edition with the headline: Two Cheers For E-Cigarettes. Today's Paper|Subscribe